A study of association of cystitis to SARS-CoV-2 infection in a tertiary care health facility

Introduction: Since December 31st, 2019, SARS-CoV-2 infection (COVID-19) has affected individuals in various ways. During this pandemic, a notable increase in patients presenting with symptoms such as frequency, urgency, burning sensation, hematuria, fever with chills, with or without minimal Influenza-like Illness (ILI), who later tested positive for COVID-19, has been observed. Hemorrhagic cystitis is the most common presenting symptom of viral urinary tract infection (UTI), and some COVID-19 survivors have presented with recurrent hemorrhagic cystitis. These observations prompted us to evaluate the risk factors and association of hemorrhagic cystitis with COVID-19 patients.
Methods: A prospective observational study was conducted among patients presenting with symptoms of cystitis in an outpatient department.
Results: Socio-demographic and clinical characteristics, laboratory and radiological findings were collected, compiled, and analyzed using SPSS ver. 17.0. Out of 152 patients with cystitis, 96 had ILI and subsequently tested positive for COVID-19, and 20 had recovered from COVID-19 in the past month. Hematuria was found as the presenting symptom in 90 (59.21%) patients, with 78 (86.67%) testing positive for COVID-19 and 12 (13.33%) testing negative. According to the Droller et al. grading system, 49% had grade 1 severity, and 32% had grade 2 severity. Diabetes was the most significant risk factor associated with hemorrhagic cystitis.
Conclusion: This study clearly demonstrates an increased prevalence of and association with hemorrhagic cystitis in COVID-19 patients in this tertiary care center. Therefore, routine investigations in SARS-CoV-2 infected cases, such as urine cytology, upper tract imaging, and cystoscopy, will aid in the early diagnosis and proactive management of COVID-19-associated cystitis.